Chapter 50 Intellectual and Developmental Disabilities Copyright 2017

Developmental Disabilities A disability occurring before 22 years of age is a developmental disability (DD). DD causes occur before, during, or after birth. Childhood illness and injuries can cause DD. Ø Some infants have birth defects. Causes include: • Genetic problems • Chromosome problems • Problems during pregnancy Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 2

Developmental Disabilities (Cont. ) A DD can be a physical or mental impairment or both. It is severe, chronic, and lifelong. Ø Function is limited in three or more life skills. • Self-care • Understanding and expressing language • Learning • Mobility • Self-direction • Capacity for independent living • Supporting oneself financially Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 3

Developmental Disabilities (Cont. ) Developmentally disabled children need lifelong help, support, and special services for: Housing Ø Employment Ø Education Ø Protection of civil and human rights Ø Health care Ø Independence to the extent possible is the goal for these persons. Copyright © 2017, Elsevier, Inc. All rights reserved. 4

Developmental Disabilities (Cont. ) A DD affects the family throughout life. Both the child and parents grow older. Ø Older parents may not have the energy or means to care for the aging child. Ø Persons with developmental disabilities have the same rights as every citizen. Their rights are also protected by: The Americans with Disabilities Act of 1990 (ADA) Ø The Developmental Disabilities Assistance and Bill of Rights Act of 2000 Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 5

Developmental Disabilities (Cont. ) Some severely disabled children live in centers for the developmentally disabled. Some adults with DDs need nursing center care. They are further protected by: Ø The Omnibus Budget Reconciliation Act of 1987 (OBRA) • OBRA requires that centers provide age-appropriate activities. • Staff must have special training to meet their care needs. Copyright © 2017, Elsevier, Inc. All rights reserved. 6

Intellectual Disabilities Intellectual disability involves severe limits in intellectual function and adaptive behavior. It occurs before age 18. Ø The person has low intellectual function. Ø Adaptive behavior is impaired. Ø The Arc of the United States describes an intellectual disability as: Ø An IQ (Intelligence Quotient) score of about 70 or below • The person learns at a slower rate than normal. • Learning ability is less than normal. Ø A significant limit in at least one adaptive behavior • Adaptive behaviors are skills needed to function in everyday life. Copyright © 2017, Elsevier, Inc. All rights reserved. 7

Intellectual Disabilities (Cont. ) Brain development is impaired. Ø It can occur before birth, during birth, or before the age of 18. • According to the Arc, alcohol is the leading preventable cause of intellectual disabilities. Intellectual disabilities can be mild to severe. Sexuality Ø Persons with intellectual and developmental disabilities have physical, emotional, and social needs and desires. • Reproductive organs develop. • Some have life partners. • Others marry and have children. Copyright © 2017, Elsevier, Inc. All rights reserved. 8

Intellectual Disabilities (Cont. ) Ø The Arc’s beliefs about sexuality include the right to: • Develop friendships and emotional and sexual • • • relationships Dignity and respect Privacy and confidentiality Freely choose associations Sexual expression Learn about sex, marriage and family, abstinence, safe sex, sexual orientation, sexual and emotional abuse Be protected from sexual harassment and abuse Decide about having and raising children Make birth control decisions Have control over their own bodies Protection from sterilization because of the disability Copyright © 2017, Elsevier, Inc. All rights reserved. 9

Down Syndrome Down syndrome (DS) is a common genetic cause of mild to moderate intellectual disabilities. Ø At fertilization, a male sex cell unites with a female sex cell. Each has 23 chromosomes. • When they unite, the cell has 46 chromosomes. • In DS, an extra 21 st chromosome is present. The fertilized cell has 47 chromosomes. The DS child has certain features caused by the extra chromosome. Many children with DS have other health problems. Dementia may appear in adults with DS. Copyright © 2017, Elsevier, Inc. All rights reserved. 10

Down Syndrome (Cont. ) Persons with DS need: Speech, language, physical, and occupational therapies Ø Health and sex education Ø A healthy diet Ø Regular exercise Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 11

Fragile X Syndrome Fragile X syndrome (FXS) is the most common form of inherited intellectual disabilities. There is a change in the gene that makes a protein needed for brain development. Ø In FXS, the body makes little or none of the protein. Ø FXS has no cure. Help is needed to reduce or eliminate problems with these common signs and symptoms. Ø Ø Ø Learning Physical Social and emotional Speech and language Sensory Copyright © 2017, Elsevier, Inc. All rights reserved. 12

Cerebral Palsy Cerebral palsy (CP) is a group of disorders involving muscle weakness or poor muscle control. Ø The defect is in the motor region of the brain. • Abnormal movements, posture, and coordination result. • The defect is from brain damage before, during, or within a few years after birth. Causes include: Lack of oxygen to the brain Ø The brain not developing properly Ø There is no cure. Copyright © 2017, Elsevier, Inc. All rights reserved. 13

Cerebral Palsy (Cont. ) Infants at risk include those who: Ø Ø Ø Ø Ø Are premature Have low birth weight Do not cry within the first 5 minutes after birth Need mechanical ventilation Have bleeding in the brain Have heart, kidney, or spinal cord defects Have blood problems Have seizures Have fetal alcohol syndrome Brain damage in infancy and early childhood also can result in CP. Copyright © 2017, Elsevier, Inc. All rights reserved. 14

Cerebral Palsy (Cont. ) Body movements and body parts are affected. The following types are the most common: Spastic cerebral palsy Ø Athetoid cerebral palsy Ø The following terms describe the body parts involved: Hemiplegia—The arm and leg on one side are paralyzed. Ø Diplegia—Similar body parts are affected on both sides of the body. Both arms or both legs are paralyzed. Ø Quadriplegia—Both arms, both legs, and the trunk and neck muscles are paralyzed. Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 15

Cerebral Palsy (Cont. ) The person with CP can have many other impairments. Care needs depend on the degree of brain damage. Disabilities range from mild to severe. Ø The goal is independence to the extent possible. • Physical, occupational, and speech therapies can help. • Some persons use braces, walkers, crutches, or Ø wheelchairs. • Some need vision and hearing aids. • Drugs can control seizures. • Surgery and drugs can help some muscle problems. Copyright © 2017, Elsevier, Inc. All rights reserved. 16

Autism is a brain disorder with no cure. Ø The child has: • Problems with social skills • Verbal and nonverbal communication problems • Repetitive behaviors and routines • Narrow interests Autism is more common in boys than in girls. The cause is unknown. Ø Genetics and environmental factors may be involved. Copyright © 2017, Elsevier, Inc. All rights reserved. 17

Autism (Cont. ) With therapy, the person can learn to change or control behaviors. Therapies include behavior modification, physical and occupational therapy, speech and language therapy, drug therapy, music therapy, diet therapy, auditory therapy, communication therapy, sensory therapies, and recreation therapy. Social and work skills are needed. Other disorders are common with autism. Ø They include fragile X syndrome and seizures. Copyright © 2017, Elsevier, Inc. All rights reserved. 18

Spina Bifida Spina bifida (SB) is a defect of the spinal column. The defect occurs during the first month of pregnancy. Ø Hydrocephalus often occurs with SB. Ø In SB, vertebrae do not form properly. Ø This leaves a split in the vertebrae with the spinal cord unprotected. SB can occur anywhere in the spine. Ø The lower back is a common site. Copyright © 2017, Elsevier, Inc. All rights reserved. 19

Spina Bifida (Cont. ) Types of spina bifida include: Ø Spina bifida occulta • • • Ø Vertebrae are closed. The spinal cord and nerves are normal. The person has a dimple or tuft of hair on the back. Often, there are no symptoms. Foot weakness and bowel and bladder problems can occur. Spina bifida cystica • • • Part of the spinal column is in a pouch or sac. A membrane or a thin layer of skin covers the sac. The pouch is easily injured. Infection is a risk. Myelomeningocele (or meningomyelocele) Copyright © 2017, Elsevier, Inc. All rights reserved. 20

Spina Bifida (Cont. ) There are two types of spina bifida cystica. Meningocele • The sac does not contain nerve tissue. • The spinal cord and nerves are usually normal. • Nerve damage usually does not occur. • Surgery corrects the defect. Ø Myelomeningocele (meningomyelocele) • The pouch contains nerves, spinal cord, meninges, and Ø cerebrospinal fluid. • Nerve damage occurs. • Loss of function occurs below the level of damage. • The defect is closed with surgery. Copyright © 2017, Elsevier, Inc. All rights reserved. 21

Hydrocephalus With hydrocephalus, cerebrospinal fluid collects in and around the brain. The head enlarges. Ø Pressure inside the head increases. Ø Intellectual disabilities and neurological damage occur without treatment. Ø Vision problems, seizures, and learning disabilities can occur. Ø A shunt is placed in the brain. It allows cerebrospinal fluid to drain from the brain. Ø The shunt must remain open (patent). Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 22